Endoscopic ultrasound (EUS)-guided drainage of bile ducts is experiencing widespread introduction into clinical algorithms and utilization of its benefits on regular basis. Various types of procedures, including EUS-guided choledochoduodenostomy, EUS-guided hepaticogastrostomy, EUSguided antegrade drainage facilitate biliary interventions particularly in those cases when endoscopic retrograde cholangiopancreatography fails or is not possible at all, for example in cases with surgically altered anatomy. Available clinical data are encouraging, but prospective and randomized controlled trials are warranted. The need for development of special tools and accessories seems to be essential for safer spreading of these procedures into algorithms of clinical care.